A 76-year-old male patient underwent emergency surgery in 1974 for a bleeding gastric ulcer.
A subtotal gastrectomy with Billroth II reconstruction was performed.
The postoperative course was normal.
In the subtotal gastrectomy specimen an ulcerated tumor was found in the anterior face, 15 mm distant from the gastric section and 3 cm from the pylorus.
The tumor measured 3.5 cm in the longitudinal axis and 7 cm in the transversal axis, compromising the lesser curvature and extending 2.5 cm to the posterior face.
At the cutting stage, it was composed of pale pink lobulated smooth and tapered tissue replacing the submucosal, muscularis propria and subserosa tunics, slightly bulging the serosa.
Histopathological examination showed a mixed lymphohistiocytic lymphocytic lymphoma of the 1966 Rappaport classification, valid until the classifications of Kiel et Hodgkin4 were established.
Lymph node involvement was not found.
The patient received adjuvant radiotherapy and was followed with annual endoscopies for 23 years.
No new gastric lesions were observed and the presence of Helicobacter pylori was not demonstrated.
During this period, the patient developed hypertension, Warthin's tumors of both parotid glands, of which only the right was resected and an epidermoid skin cancer in the right lower extremity.
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In September 2006, 32 years after gastric surgery, the patient consulted for symptoms of anemia.
Physical examination revealed paleness without abdominal masses.
Hematocrit was 34.5% and an upper endoscopy showed a proliferative ulcerated lesion in the gastric stump that partially occluded the gastrojejunal anastomosis.
The pathological study showed that the gastric mucosa was closed due to a moderately differentiated tubular adenocarcinoma.
Helicobacter pylori was not found.
Computed tomography of the chest, abdomen and pelvis were normal.
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The patient underwent total gastrectomy with lymph node dissection.
Postoperative recovery was normal.
The anatomopathological study of the surgical specimen showed an ulcerated tumor lesion in the gastric stump with remnants of the gastrojejunal anastomosis.
The microscopic study showed a moderately differentiated tubular adenocarcinoma with involvement of the subserosa of the gastric wall, metastasis in 10 lymph nodes of 16 resected and lymphatic vascular permeations (T2bPN2M0, Eta).
